Doctor’s Note: The antibiotics paradox

We prescribe too many antibiotics throughout the world and some predict that by the middle of this century, the planet will be a much worse place because of antibiotic-resistant diseases.

It’s similar to the warnings about global warming, which went largely ignored for a long time—the problem of emerging antibiotic resistance requires tough decisions to avert disaster.

The ability of bacteria, viruses and fungi to develop resistance causes the antibiotics in use today to be less effective or not effective at all. It’s predicted that the death rate from infections by resistant organisms will increase 10 times by the year 2050, and the cost estimate to deal with antibiotic resistance from now until mid-century is $100 trillion.

Indirectly, many other medical treatments and procedures will become more difficult if a majority of bacteria are resistant to the antibiotics that we have available. Knee and hip replacements, most forms of general surgery, organ transplants, and cancer treatment all depend on effective antibiotics to prevent patient infection.

Another factor affecting antibiotic resistance is that drug companies are doing less research and development for the creation of new antibiotics, compared to many other categories of drugs. Since they were discovered and we began treating patients with them in the 1940s, we’ve overcome the problems generated by resistant organisms by developing many different and unique kinds of antibiotics.

One reason for this lack of research is greed: developing a new antibiotic isn’t as lucrative as selling another cholesterol-lowering medication, or another Viagra. Since medical literature is instructing doctors to use fewer antibiotics, creating one that will be as profitable as other categories of medicine becomes less likely.

Greed is also one of many responsible factors in the overuse of antibiotics. I often ask my medical students, “To whom are most of the antibiotics produced by drug companies sold in America?” Believe it or not, 70 percent of all antibiotics produced are sold to farmers and to agribusiness. The bottom line is that antibiotic use in livestock and chickens creates more profit.

What can we do about this problem? As a physician offering primary care to many patients who come in with acute infections, it’s imperative to educate the patient—and sometimes myself—that most infections are caused by viruses and won’t improve with any antibiotic, but will with a little patience. Sinusitis, bronchitis, the common cold, and most ear infections fit into this category.

We need to improve sanitation in the developing world to decrease the number of bacteria that are germinating and creating resistance. In the developed world, decreasing the rate of hospital-acquired infections will lessen the need for stronger antibiotics.

We should give fewer antibiotics to the animals that we plan to eat; limit the worldwide sale of antibiotics without a prescription or through the Internet; and develop more vaccines to help prevent infections in the first place. We should also use the ones we have, like the pneumonia vaccine, more effectively.

Like global warming, it’s easy to ignore the problems of antibiotic overuse and resistance, and not take the hard steps to correct them.

I was inspired to write about this topic by the science writer Ed Yong and his recent story “The Plan to Avert Our Post-Antibiotic Apocalypse,” published in The Atlantic magazine. I hope bringing attention to this issue will help bring about the necessary changes to our relationship with antibiotics.

Dr. Jeff Daniels has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.